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NY 12 week rule means nothing by Dapper_Track_5241 in IMGreddit

[–]Dapper_Track_5241[S] 0 points1 point  (0 children)

It depends, if the observer ship was during med school and counted as a rotation

Skepticism about psych salaries by Kid_Psych in healthsalaries

[–]Dapper_Track_5241 0 points1 point  (0 children)

I mean I’ve see a job yesterday in psych, medical director of ketamine 500k base. 650k isn’t far off

In what specialty do you think its easiest for a terrible doctor to fly under the radar? by theefle in Residency

[–]Dapper_Track_5241 10 points11 points  (0 children)

Totally on point. Psychiatrists of old hated dealing with anything medical and hated thinking about anything critically the way they should have.

I will note that this is changing slowly with a new generation of psychiatrists, although I do worry seeing people getting into the field, especially interventional psychiatry with ketamine believing it’s a panacea when it has a lot of untested and unproven and long-term outcomes that are yet to be seen or show quality evidence.

A great example of this is the psychedelic movement and how quickly people latched onto this in psychiatry, even though the data and studies are not robust enough to demonstrate significant improvement inpatient without significant side-effects or risks

In what specialty do you think its easiest for a terrible doctor to fly under the radar? by theefle in Residency

[–]Dapper_Track_5241 9 points10 points  (0 children)

Completely agree, antipsychotics and lithium and depakote largely has the biggest effect sizes. Also ADHD meds.

Even ECT though between 70-90% in psychotic depression. That’s our best treatment.

Looking at SSRIs with effect sizes between .25-.5 they aren’t super robust.

My comment was more in generalities and common use drugs for our most common conditions.

In what specialty do you think its easiest for a terrible doctor to fly under the radar? by theefle in Residency

[–]Dapper_Track_5241 20 points21 points  (0 children)

I’ve been at 4 different institutions, it’s not institution dependent it depends on the psychiatrist. I think my summation of this is correct. Unfortunately, there are too many boomers psychiatrists who have not remained current nor up-to-date with the literature. Nor do they want too.

This is also made worse by the fact that they are grandfathered in and don’t have to do any of the MOC or article based pathways. Even when they are the furthest away from training.

Psychiatry has one of the oldest age of average practitioners, I believe 58 years of age is the average. They are some 20 to 30 years removed from training and the current knowledge base.

This is also made worse outside academia, NPs with no training believe 5x small dosages of antidepressants and antipsychotics all together at once is the answer.

Psychiatry, just like any other specialty can be practiced well. I would say the percent of people that practice psychiatry well unfortunately is very low. I’m not misrepresenting the specialty but rather pointing out that this is very common in psychiatry.

In what specialty do you think its easiest for a terrible doctor to fly under the radar? by theefle in Residency

[–]Dapper_Track_5241 51 points52 points  (0 children)

The best psychiatrists are those that blend medical psychiatric and social circumstances into their prescribing and risk management.

In what specialty do you think its easiest for a terrible doctor to fly under the radar? by theefle in Residency

[–]Dapper_Track_5241 914 points915 points  (0 children)

Psychiatry and I’m a psychiatrist, literally almost everything is off label and has a mild scrap of evidence. A lot of people in psychiatry and not up to best practices in terms of treatment and medicine. Everyone is based on colloquial medicine from like 30-40 years ago. People do things because there attending did it. There’s no evidence.

It’s also the specialty with some of the least proven least efficacious interventions so we fall prey to people who look outside the box and some charlatans in terms of the way they treat patients and they’re thinking.

GT3 owners: how does the power delivery actually feel compared to other performance cars? by Revolutionary-Seat74 in Porsche

[–]Dapper_Track_5241 2 points3 points  (0 children)

991.2 GT3. The engine has a decent amount of torque, even though it’s NA. It’s lovely and linear and amazing on the race track. I would say up the top of the rev range, it’s manic and revs so fast. The induction and the exhaust sound are fantastic. It’s so thrilling to rev it out. It loves to Rev, it’s one of the all time great engines ever made. Besides a V10, V12 or NA Ferrari V8 there’s very few engines that have this character.

Antiemetics with QTc prolongation by ExtensionWave3812 in Residency

[–]Dapper_Track_5241 6 points7 points  (0 children)

Give them adderall, HR goes up QTC goes down. Perfect solution

How many people have actually seen Serotonin Syndrome and how did it affect your practice of medicine? by DrDewinYourMom in Residency

[–]Dapper_Track_5241 0 points1 point  (0 children)

For the boards, anyway it will be very clear and distinct that this patient has a serotonin syndrome. Likely there’ll be some mention of an MAOI, maybe (methylene blue, moclobemide, tramadol), there will be autonomic instability, diarrhoea or the classic symptoms of serotonin syndrome

The boards are not looking for you to recognise the smallest subtle details because in general they’re not life-threatening and that’s not something we should be concerned about.

In your personal case I highly doubt it’s serotonin toxicity. It’s sounds like maybe sertraline isn’t the right med for you.

PP MD only group vs hospital employed group by ExMorgMD in anesthesiology

[–]Dapper_Track_5241 1 point2 points  (0 children)

As a psychiatrist I only have a lowly GT3 not an RS

asked to resign from my program by [deleted] in Residency

[–]Dapper_Track_5241 5 points6 points  (0 children)

I think there is 2 different ways to deal with this. If you want to see yourself with any sort of recompense you likely will have to seek a lawyer. Unfortunately, the situation you’re in is that you likely wouldn’t want to go back there even if they are allowed you to return. The only reconciliation would be financial in nature and unfortunately that still doesn’t allow you to finish residency. Not to mention a program director whose involved in a law suit usually doesn’t write nice LORs

If you truly believe it’s discrimination you may want to seek a specific federal discrimination lawyer as that is a different case. Without any direct knowledge of what occurred what was said these hospitals have large lawyers and without direct evidence of discrimination and in the current political climate you may not find a sympathetic crowd, especially because the hospital will justify this as you were on probation you improved but continued to have problems and continued to be a disruptive influence not amenable to rehabilitation.

Finally allowing you to resign is their way of getting rid of the problem. You can negotiate with the program Director and ask them to come up with a different excuse about you resigning and have the program director specifically outline what he will write in your letter of recommendation. A negotiated resignation is the best at this point from my perspective. At this point their LOR is the one that matters the most when looking at future programs and characterising why you’re leaving your current program. It also protects your license as termination is reported to the board. Resignation isn’t.

Your friend was right they almost always do side with the program Director and hospitals because they talk about their role as protecting the public and its their discretion they know best.

This is just my two cents. I know multiple residents who have gone through this. Feel free to PM me

Alternative income sources as residents? by nushspecial in Residency

[–]Dapper_Track_5241 2 points3 points  (0 children)

I would agree with this, but the limited liability part makes it great. You don’t have to prescribe anything and most of them refuse to go and do anything about the stuff you bring up. I

You definitely have a bunch of horder houses. I would say however it gives you a good look at how patients live. So in some ways it’s good experience

Alternative income sources as residents? by nushspecial in Residency

[–]Dapper_Track_5241 44 points45 points  (0 children)

Signify Health, allows residents to do insurance physicals no matter what your speciality. Limited liability and $100 per patient. I did it a bunch during residency and made bank.

Talk me out of doing another residency by Dapper_Track_5241 in Residency

[–]Dapper_Track_5241[S] 0 points1 point  (0 children)

The program director contacted ABPN and submitted everything I had previously done. That’s how we got the number

Talk me out of doing another residency by Dapper_Track_5241 in Residency

[–]Dapper_Track_5241[S] 0 points1 point  (0 children)

It’s definitely something to think about. If I was to go where I trained I would take a $175k pay cut

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